A 14-month-old girl with a history of premature delivery at 34 weeks’ gestation presents to a general pediatrics clinic for evaluation of yellow hands and feet. A family member first brought the discoloration to the mother’s attention 1 week ago. The mother is not aware of her daughter being exposed to any yellow or orange substances and is concerned because the discoloration has remained despite multiple attempts to wash with soap. On review of systems, her mother does not report any recent illnesses, fever, weight change, yellowing of the eyes, abdominal pain, constipation, periorbital edema, extremity swelling, or changes in the color of her daughter’s stool or urine. There is no family history of carotenemia or endocrine, liver, or renal disease. She is not taking any medications or nutritional supplements. A detailed dietary history reveals that she consumes 8 oz (224 g) of cow milk, table foods, and 16 oz...

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